Surgical Pearl: A Wound Dressing Tip for Venous Ulcers

Venous ulcers are the most common form of leg ulcers. Up to 80% of leg ulcers are the result of chronic venous hypertension, most commonly caused by valvular incompetence.¹ When used with a foam dressing, one commonly used treatment—a multilayer compression wrap—may result in further skin damage. The authors present a method of preventing this occurrence.
Graduated external compression plays a major role in the successful treatment of venous ulcers.² The application of external compression can help minimize or reverse changes in the skin and vascularity induced by chronic venous hypertension by forcing fluid from the interstitial spaces back into the vascular and lymphatic compartments.² Multilayer compression bandages are elastic compression bandages that work via constant compressive forces.³ The bandages provide sustained pressures of 40 to 45 mmHg at the ankle graduating downward to 17 mmHg below the knee.¹
Moisture-retentive dressings can be used in conjunction with compression therapy.³ Foam dressings are absorbent dressings often used beneath compression bandages.⁴ These polyurethane materials⁵ absorb wound drainage 4 times more than hydrocolloid dressings of similar sizes.⁶ Polyurethane materials have the advantage of not adhering to the wound or surrounding skin, which makes them attractive when treating fragile skin often found in the elderly.⁵ Foam dressings are usually supplied as square pads of different sizes with steep edges.
The authors found that the thick variant (4 mm–7 mm) of foam dressings⁴ applied on patients with venous ulcers beneath multilayer compression bandages often results in deep indentation at the site where the foam edges are in contact with the skin. This can sometimes result in painful erosions or even development of new ulcers (Figure 1). The outer compression bandage is usually applied in a figure-of-eight fashion and the second layer in a spiral fashion with a 50% overlap between turns. This application technique can produce larger numbers of layers at any one point and, therefore, create higher sub-bandage pressures.² This high pressure is constantly exerted against the sharp, steep edges of the thick foam resulting in a continuous digging of these edges through the skin.

Technique

The authors have employed a simple technique, which resulted in a marked decrease in skin indentation marks and erosions. The edges of the foam dressing are tapered using scissors (Figure 2). The tapering results in a much smaller column of foam compressing the skin under the compression bandage. No patients have developed skin erosions at the edge of foam dressings since initiating the use of the tapered foam dressing technique (Figure 3).

Conclusion

The commercial development of a foam dressing with tapered edges would make a great difference in the care of venous ulcer patients. In the meantime, this modification can simply be done at the bedside.